Ministry of Health Malaysia MOH Malaysia MOH Malaysia ’ ’ s s Preparedness In Dealing Preparedness In Dealing With PHEIC In Compliance With PHEIC In Compliance to IHR 2005 to IHR 2005 Dr Devan Kurup Dr Devan Kurup Outbreak & Disaster Management Sector Outbreak & Disaster Management Sector Disease Control Division Disease Control Division MINISTRY OF HEALTH MALAYSIA MINISTRY OF HEALTH MALAYSIA
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MOH Malaysia’s Preparedness In Dealing With … of Health Malaysia MOH Malaysia’s Preparedness In Dealing With PHEIC In Compliance to IHR 2005 Dr Devan Kurup Outbreak & Disaster
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Ministry of Health Malaysia
MOH MalaysiaMOH Malaysia’’s s Preparedness In Dealing Preparedness In Dealing
With PHEIC In Compliance With PHEIC In Compliance to IHR 2005to IHR 2005
Disease Control DivisionDisease Control DivisionMINISTRY OF HEALTH MALAYSIAMINISTRY OF HEALTH MALAYSIA
Presentation LayoutPresentation Layout
Introduction: IHR & PHEIC in briefIntroduction: IHR & PHEIC in brief
IHR Core Capacity Monitoring FrameworkIHR Core Capacity Monitoring Framework
MOH MalaysiaMOH Malaysia’’s Compliance to IHRs Compliance to IHR
Public Health Surveillance, Preparedness & Public Health Surveillance, Preparedness & ResponseResponse
Selected Health Threats Encountered & Selected Health Threats Encountered & Responded by MOH MalaysiaResponded by MOH Malaysia
Way ForwardWay Forward
International Health Regulations (IHR) 2005International Health Regulations (IHR) 2005
The International Health Regulations (2005) (hereinafter "the The International Health Regulations (2005) (hereinafter "the IHR" or IHR" or ““the Regulationsthe Regulations””) is an international agreement that ) is an international agreement that is legally binding on 194 countries (States Parties). is legally binding on 194 countries (States Parties). The IHR define their "purpose and scope" as: "to prevent, The IHR define their "purpose and scope" as: "to prevent, protect against, control and provide a public health response protect against, control and provide a public health response to the international spread of disease in ways that are to the international spread of disease in ways that are commensurate with and restricted to public health risks, and commensurate with and restricted to public health risks, and which avoid unnecessary interference with international which avoid unnecessary interference with international traffic and trade". traffic and trade". Since their entry into force on 15 June 2007, the IHR directs Since their entry into force on 15 June 2007, the IHR directs and governs particular WHO and States Parties activities and governs particular WHO and States Parties activities aiming that protect the global community from public health aiming that protect the global community from public health risks and emergencies that cross international borders.risks and emergencies that cross international borders.
INTERNATIONAL HEALTH REGULATIONS 2005
Adopted at the 58th World Health Assembly in Geneva in May 2005, the IHR (2005) entered into force on 15 June 2007 and becomes legally binding in all WHO Member states.
The International Health Regulations 2005 (IHR 2005) is an International legally binding regulations to protect global public health threats of infectious diseases and other PH emergencies. Any public health emergency of international concern, be it biological, chemical or radiological.
3 TOP PRIORITIES –
ENTRY INTO FORCE
Assess & Strengthen National Capacities:
Annex 1A & 1B
National IHR Focal Point
WHOAssess & Notify PHEIC:Annex 2
DEPUTY DIRECTOR GENERAL OF HEALTH (PUBLIC HEALTH), MOH M’SIA
What is a Public Health Emergency of What is a Public Health Emergency of International Concern (PHEIC)?International Concern (PHEIC)?
An Extraordinary Public Health EventAn Extraordinary Public Health Event
that constitutes a public health risk to other that constitutes a public health risk to other countries through its international spreadcountries through its international spread
That may require a coordinated international That may require a coordinated international responseresponse
The IHR 2005 requires notification to WHO The IHR 2005 requires notification to WHO of any event that may constitute a PHEICof any event that may constitute a PHEIC
IHR (2005) : Annex 2 Assess public health events by using the decision instrument and
notify within 24 hours, of all events that may constitute a public health emergency of international concern
Events that may constitute a PHEICEvents that may constitute a PHEIC--11
A case of the following A case of the following shallshall be notified:be notified:--
SmallpoxSmallpox
Poliomyelitis due to wild type Poliomyelitis due to wild type poliomyelitispoliomyelitis
Human influenza caused by a new Human influenza caused by a new subtypesubtype
Severe Acute Respiratory Syndrome Severe Acute Respiratory Syndrome (SARS)(SARS)
Events that may constitute a PHEICEvents that may constitute a PHEIC--22An event involving the following need to assessed An event involving the following need to assessed due to their ability to cause serious public health due to their ability to cause serious public health impact & to spread rapidly internationally & needs impact & to spread rapidly internationally & needs the use of PHEIC decision instrument for the use of PHEIC decision instrument for assessment and possible notification.assessment and possible notification.
Other diseases of special national or regional concernOther diseases of special national or regional concern
Events that may constitute a PHEICEvents that may constitute a PHEIC--33
An event of potential international public An event of potential international public health concern, including those of causes or health concern, including those of causes or sources and those involving other events or sources and those involving other events or diseases than those listed in Slides PHEICdiseases than those listed in Slides PHEIC--1 1 and PHEICand PHEIC--2. 2.
This needs the use of the PHEIC decision This needs the use of the PHEIC decision instrument for assessment and possible instrument for assessment and possible notification.notification.
MEMBER STATES KEY OBLIGATIONS
Designate or establish a National IHR Focal Point;
Strengthen and maintain the capacity to detect, report and respond rapidly to public health risks & PHEIC (Public Health Emergency of International Concern);
Respond to requests for verification of information regarding potential PHEIC;
Collaborate with other States Parties and with WHO concerning IHR(2005) implementation;
MEMBER STATES KEY OBLIGATIONS…..Cont.
Assess public health events by using the decision instrument and notify within 24 hours, of all events that may constitute a public health emergency of international concern.
Provide routine inspection and control activities at designated international airports, ports and ground crossings to prevent the international spread of disease
Make every effort to implement WHO-recommended measures
IHR Core Capacity Monitoring FrameworkIHR Core Capacity Monitoring Framework28 Page Questionnaire for Monitoring Progress in the 28 Page Questionnaire for Monitoring Progress in the Implementation of IHR Core Capacities in the States Parties Implementation of IHR Core Capacities in the States Parties (Core Capacity(Core Capacity--ComponentComponent--Indicator)Indicator)
The IHR Sec required to provide an annual report to the WHAThe IHR Sec required to provide an annual report to the WHA
WHO & States Parties Progress on IHR ImplementationWHO & States Parties Progress on IHR Implementation
Core Capacities include National Legislation (5Q), Core Capacities include National Legislation (5Q), Coordination & NFP Communication (18Q), Surveillance Coordination & NFP Communication (18Q), Surveillance (18Q), Response (27Q), Preparedness (21Q), Risk (18Q), Response (27Q), Preparedness (21Q), Risk Communication (10), Human Resource Capacity (7Q), Lab Communication (10), Human Resource Capacity (7Q), Lab (22Q), POEs (35Q), Zoonotic Events (13Q), Food Safety (24Q), (22Q), POEs (35Q), Zoonotic Events (13Q), Food Safety (24Q), Chemical Events (18Q), & Radiation Emergencies (17Q)Chemical Events (18Q), & Radiation Emergencies (17Q)
Requires multiagency involvement and commitmentRequires multiagency involvement and commitment
Use of this format by States Parties is entirely voluntaryUse of this format by States Parties is entirely voluntary
Ministry of Health Malaysia
MOH MALAYSIAMOH MALAYSIA’’S S COMPLIANCE TO COMPLIANCE TO
IHRIHR
The Proven Value of Crisis ManagementThe Proven Value of Crisis ManagementReduces
the total impact
and speeds
recovery from all kinds of health crises.
Reduces
the total impact
and speeds
recovery from all kinds of health crises.
Without Crisis Readiness
Without Crisis Readiness
Damage toFinancial Results, Reputation and Key Relationships
Damage toFinancial Results, Reputation and Key Relationships
Lost Time/ProductivityLost Time/Productivity
CrisisEventCrisisEvent
With Crisis Readiness
With Crisis Readiness
IMPACTIMPACT
TIME
CRISIS
READINESS
Warning Indicators(Flash Points)
WARNING PHASE
Months / Weeks / Hours
EMERGENCYPHASE
Days / Weeks
MitigationPreparedness
Search & RescueEmergency Relief
Rehabilitation
Reconstruction
Ongoing Development
Rapid / Detailed Assessment
SuddenImpact
Rehabilitation / Recovery
Many Months
TIME
AC
TIVITY
12
34 5
Emergency Response and RecoveryEmergency Response and Recovery
Selected Global Frameworks
International Health Regulations (2005)Biological & Toxin Weapons Convention (BTWC)Chemical Weapons Convention (CWC)Hyogo Framework for Action 2005-2015UN Framework Conventions on Climate ChangeAsia Pacific Strategy for Emerging Diseases (APSED) 2010Codex AlimentariusOther frameworks for specific hazards (chemical safety, radiation etc)WHA and Regional Committee resolutions
WHA, resolution 64.10 (2011)
18
OUTBREAKRESPONSE
RegionalCollaboration& cooperation
WHY
HealthEconomicPublic confidence
Infectious Diseases
Mass population movementTransportation of live animal & produceExpanding air travelEncroached territories
Public Health
Medical
Laboratory
Administration
b) Provide PH assessment & care for affected travellers, animals, goods by establishing arrangements with medical, veterinary facilities for isolation, treatment & other services
c)
Provide space, separate from other travellers in in order to interview suspect or affected persons
d) Provide for assessment, quarantine of suspected or affected travellers
e) To apply recommended measures, disinsect, disinfect, decontaminate, cargo, containers, conveyances, goods, etc.
f) To apply entry/exit control for departing & arriving passengers
g) Provide access to required equipment, personnel with protection gear for transfer of travellers with infection/ contamination
POE - Capacity requirements for responding to PHEIC
Point Of Entry - Capacity requirements for responding to PHEIC
a) Emergency response plan, coordinator, contact points for relevant PoE, PH & other agencies
20
PH response PH response ––surveillance systems surveillance systems
A functional INFECTIOUS DISEASE A functional INFECTIOUS DISEASE SURVEILLANCE SYSTEM in place SURVEILLANCE SYSTEM in place
Estimate disease burden Estimate disease burden Determine disease trends Determine disease trends Prediction of outbreaks Prediction of outbreaks
Surveillance Systems in Malaysia Surveillance Systems in Malaysia --
MOHMOH
24
PreparednessPreparedness
Is the KEY to substantially reducing the health, social Is the KEY to substantially reducing the health, social and economic impact of infectious disease outbreaksand economic impact of infectious disease outbreaksPrudent preparation can limit spread and lessen effectPrudent preparation can limit spread and lessen effectReadiness = capabilityReadiness = capability
ResourcesResourcesSkillSkillKnowledgeKnowledge
Good surveillance mechanismGood surveillance mechanism
Comprises ofComprises ofRAPID ASSESSMENT TEAM (RAT)RAPID ASSESSMENT TEAM (RAT)RAPID RESPONSE TEAM (RRT)RAPID RESPONSE TEAM (RRT)
Rapid Assessment And Rapid Assessment And Response TeamResponse TeamOutbreak/Crisis /
Disaster CRISIS PREPAREDNESS AND RESPONSE CENTRE
(CPRC)
CRISIS PREPAREDNESS AND RESPONSE CENTRE
(CPRC)
Public Health Laboratory
Public Health Laboratory
Hospitals & LaboratoriesHospitals & Laboratories
RRT (N)
RRT (N)
RRT(S)
RRT(S)
RRT(D)
RRT(D)
Rapid Assessment Team (RAT)
Rapid Assessment Team (RAT)
PUBLIC HEALTH RESPONSE
Ministry of Health Malaysia
RAPID ASSESSMENT TEAMRAPID ASSESSMENT TEAM (RAT)(RAT)
Main function is at district levelMain function is at district levelVerify the occurrence of health Verify the occurrence of health crisiscrisisUndertake risk analysis and needs Undertake risk analysis and needs assessmentassessmentAssess the severityAssess the severityAction depends on the complexity Action depends on the complexity / extend of the outbreak / extend of the outbreak /situation./situation.Members: Members:
RAT RAT –– must have a sense of urgencymust have a sense of urgency
What the stakeholder wants to know– Situation
What happenWhere it happenWho is affectedHow did it happen
– Send information via SMS / call
RESPONSE RESPONSE MECHANISM MECHANISM
OutbreakOutbreakDistrict Health OfficeDistrict Health Office
Rapid Assessment Team (RAT)Rapid Assessment Team (RAT)
State Heath Office State Heath Office
Ministry of HealthMinistry of Health
RapidResponse Team (RRT)
RapidResponse Team (RRT)
Ministry of Health Malaysia
RAPID RESPONSE TEAM RAPID RESPONSE TEAM (RRT) (RRT)
A preA pre--determined team based on determined team based on individual expertise and experience individual expertise and experience matched to meet the unique demands of matched to meet the unique demands of the incidentthe incident
Team approach with the MOH / Epid Officer Team approach with the MOH / Epid Officer being the Maestro being the Maestro
Function from district, state or national Function from district, state or national level depending on extend and level depending on extend and complexity of the outbreak /situationcomplexity of the outbreak /situation
Ministry of Health Malaysia
RAPID RESPONSE TEAM RAPID RESPONSE TEAM (ROLES & FUNCTIONS) (ROLES & FUNCTIONS)
to analyse and act on surveillance informationto analyse and act on surveillance informationto plan control and response strategiesto plan control and response strategiesto identify additional resources needed for to identify additional resources needed for
rapid response.rapid response.to investigate and manage the outbreakto investigate and manage the outbreakto collaborate and coordinate with other to collaborate and coordinate with other
relevant agencies relevant agencies to evaluate the effectiveness of the response to evaluate the effectiveness of the response
and intervention measuresand intervention measuresto produce a detailed reportto produce a detailed reportto predict and plan for the management of to predict and plan for the management of
future outbreaksfuture outbreaks
Ministry of Health Malaysia
FIRST 12FIRST 12--24 HOURS 24 HOURS
Verify the situationVerify the situationRAT, RRTRAT, RRT
Conduct notificationsConduct notificationsAssess the level of crisisAssess the level of crisis
Actions & measures taken prior to & during the outbreak will determines the desired outcome
35
Flow chart Outbreak
Physician / pediatrician Lab –District / State
Dpty. Director(Medical)
Dpty. Director (PH)/Epid Officer
MOH Incident Command Centre (CPRC)
(Surveillance Section)
Dpty. DG (PH) / Director Disease Control
Hospital Director
District MOH
State Health Director
Director General of Health
YB Minister /Sec-General
WHO / Others
IMR /NPHL
NATIONAL COMMAND CENTRE ORGANIZATION CHART
Inter‐ministry Crisis‐Disaster Committee(Chairman: Minister of Health)
Ministry of Health Crisis‐Disaster Technical Committee
(Chairman: Director General of Health)
National Command Centre(Chairman: DDG (PH) /Director Disease Control)
Logistic
Secretariat Supplies and
Procurement Health Information
and Promotion Guideline
Surveillance and
Epidemiology
Independent Expert Team
NATIONAL COMMAND CENTRE ORGANIZATION CHART
Director
:
Director of Disease Control Responsible to
:
Ministry of Health Outbreak Technical Committee Chairperson (DG/DDG (PH))
Members
:
All chairpersons of the Units/teams Secretariat UnitSurveillance and Epidemiology UnitSupplies and Procurement UnitHealth Promotion and Information UnitGuidelines UnitLogistic Unit
Task
:
Issuing directive and commands Chair National Operations Room meetingOversees overall outbreak response
STATE COMMAND CENTRE ORGANIZATION CHART
State Crisis‐Disaster Committee(Chairman: State Health EXCO/State Secretary )
State Health Department Crisis‐Disaster Technical Committee(Chairman: State Health Director)
State Command Centre(Chairman: State Operation Room Director)
Secretariat Technical
Information Unit Health
Information UnitSupport Unit
Independent Expert Team
STATE COMMAND CENTRE ORGANIZATION CHART
DISTRICT COMMAND CENTRE ORGANIZATION CHART
District Crisis‐Disaster Committee(Chairman: District Officer)
District Health Department Crisis‐Disaster Technical Committee
(District Health Officer)
District Command Centre(Chairman: District Operation Room Director)
Secretariat EnforcementInvestigation
TeamControl Unit
Independent Expert Team
Support Team
DISTRICT COMMAND CENTRE ORGANIZATION CHART
Chairperson
:
Medical Officer of Health
Members
:
Heads of all UnitsSecretariat UnitSupport UnitInvestigation Unitcontrol UnitEnforcement
Task
:
Issuing directives and commands Oversees overall outbreak response Epidemiological analysis of outbreakReport writingFinal report
42
Risk communicationRisk communicationProviding a customised regular & updated information Providing a customised regular & updated information package targetted at:package targetted at:
StakeholdersStakeholdersMediaMediaPublicPublic
MethodsMethodsUsing health channels Using health channels
Web site. FAQs, pamphlets Web site. FAQs, pamphlets Avenues for publicAvenues for public
HotlinesHotlinesMass mediaMass media
43
Speed of Information FlowDISTRICT
STATE
MOH INCIDENT COMMAND CENTRE (CPRC)(DIRECTOR OF DISEASE CONTROL)
YB MINISTER
DG
DDGs
OTHER AGENCIES
Between 4.00 -
6.00pm
You need to set the time appropriately
By 8.00 am next day
By 12.00 noon
Ministry of Health Malaysia
Health Threats Encountered By Health Threats Encountered By the the
Ministry of HealthMinistry of Health
Ministry of Health Malaysia
Real Risk of importationReal Risk of importationMalaysia and region at risk of importation of exotic Malaysia and region at risk of importation of exotic and novel biological agents:and novel biological agents:--
Wild poliovirus infection in 1992Wild poliovirus infection in 1992Visceral Leishmaniasis (Kala Azar) in 1993Visceral Leishmaniasis (Kala Azar) in 1993Chikungunya viral infection in 1998Chikungunya viral infection in 1998Nipah viral encephalitis in 1998/99Nipah viral encephalitis in 1998/99Menangle/Tioman Virus in 2000Menangle/Tioman Virus in 2000Cholera 0139 in 2002Cholera 0139 in 2002SARS in 2003 (SEARO & WPRO)SARS in 2003 (SEARO & WPRO)Avian influenza (H5N1) in 2004 (SEARO & WPRO)Avian influenza (H5N1) in 2004 (SEARO & WPRO)Pandemic H1N1 2009Pandemic H1N1 2009??? future importations (H7N9??? future importations (H7N9--WPRO) (MERS WPRO) (MERS CoVCoV--EMRO) (?select biological agents)EMRO) (?select biological agents)
THE CHALLENGES
ComplexityExpenditure
Anthrax scares
Dioxin contamination-Economic Loss
TimeEV71-Sarawak-131 Deaths
Nipah (N.Sembilan)-107deaths
SARS-Economic Loss 1% GDP
Pandemic H1N1(2009)-Economic Loss
Tsunami , 2005
Disaster Crisis
Tsunami-GEJE
Highland Towers-48 deaths
Mud Flood(Perak)-44 deaths
Tropical Storm-
(Sabah)-238 deaths
Malaysia
..countries affected
…death…morbid
% global GDP
Unpredictable - time, place, method, target, collateral damage
Likely to severely test organizationalEmergency Risk management capabilities
..countries affected
…death…morbid
% global GDP
Unpredictable - time, place, method, target, collateral damage
Likely to severely test organizationalEmergency Risk management capabilities
Challenges Challenges ––emergence of emergence of infectious disease outbreaks infectious disease outbreaks
Over the past 40 years, 39 new infectious diseases have been disOver the past 40 years, 39 new infectious diseases have been discovered, 20 covered, 20 diseases are now drugdiseases are now drug--resistant, and old diseases have reappeared. About resistant, and old diseases have reappeared. About 75% of emerging pathogens are zoonotic. 75% of emerging pathogens are zoonotic. New diseases with old infectious agentsNew diseases with old infectious agents
New diseases with new infectious agentsNew diseases with new infectious agentsNipah, SARS, Ebola, HPAI, Pandemic (H1N1) 2009Nipah, SARS, Ebola, HPAI, Pandemic (H1N1) 2009
Old disease in new locationsOld disease in new locationsWest Nile Virus, Rift Valley Fever, Chikungungya, Kala AzarWest Nile Virus, Rift Valley Fever, Chikungungya, Kala Azar
50
Major ID outbreaks Major ID outbreaks –– Economic impact Economic impact
“ …… At this point, further spread of the pandemic, within affected countries and to new countries, is considered inevitable.
This assumption is fully backed by experience. The 2009 influenza pandemic has spread internationally with unprecedented speed. In past pandemics, influenza viruses have needed more than six months to spread as widely as the new H1N1 virus has spread in less than six weeks. ….”
Safe work place Safe work place Public order & securityPublic order & securityCommunity mobilizationCommunity mobilizationEntry points in to the country Entry points in to the country Inter & intra agency involvementInter & intra agency involvementInternational relationsInternational relations
International Health Regulations 2005International Health Regulations 2005
64
PH response PH response –– Human resource Human resource
Healthcare personnel needs and protection Healthcare personnel needs and protection Vaccination Vaccination PPEsPPEsHealth screening Health screening SOPs & GuidelinesSOPs & GuidelinesHealth talksHealth talksTrainingTrainingWork safety (Biorisk Mx)Work safety (Biorisk Mx)
HospitalHospitalLaboratoryLaboratoryFieldField
Medical responseMedical response
Notification & reporting Notification & reporting Triaging and isolationTriaging and isolation
Fever clinics Fever clinics
Clinical managementClinical managementEarly diagnosis & confirmationEarly diagnosis & confirmationTimely isolation & appropriate treatmentTimely isolation & appropriate treatmentDecontamination facilities Decontamination facilities Designated hospitals with specialized ID servicesDesignated hospitals with specialized ID services
A document which serves as a time bound guide A document which serves as a time bound guide for preparedness and response plan for influenza for preparedness and response plan for influenza pandemicpandemicContain specific advice and actions to be taken by Contain specific advice and actions to be taken by MOH and other relevant agencies & NGOsMOH and other relevant agencies & NGOsEnsure resources are mobilized and used most Ensure resources are mobilized and used most efficientlyefficientlyUndergoing revision and updating to meet Undergoing revision and updating to meet current/future needscurrent/future needs
National Influenza Preparedness Pandemic National Influenza Preparedness Pandemic Plan (NIPPP)Plan (NIPPP)–– an example of collective an example of collective
preparedness & responsepreparedness & response
National Influenza Pandemic Preparedness Plan (NIPPP)
Preparation started in 2003
Prepared by National Influenza Pandemic Planning Committee –multidisciplinary, inter-agencies/departmental and experts.
Launched on 9 Jan 2006 by Minister of Health
Documents available on website
NIPPP – Strategies
Organizational Response –3 main committees
Public Health Response
Medical Response
Laboratory Response
Risk Communication
Social Response
National Influenza Preparedness National Influenza Preparedness Pandemic PlanPandemic Plan
Public Health Response Public Health Response Surveillance of ILISurveillance of ILIPrevention & Control measuresPrevention & Control measuresCoordination with relevant agencies Coordination with relevant agencies Travel advisories Travel advisories SelfSelf––health monitoring health monitoring Training & simulation exercisesTraining & simulation exercisesInformation dissemination &Information dissemination &Risk communicationRisk communication
National Influenza Preparedness National Influenza Preparedness Pandemic PlanPandemic Plan
Medical ResponseMedical ResponseClinical case definition & admission criteria Clinical case definition & admission criteria
Stockpiling of essential drugs / vaccines / Stockpiling of essential drugs / vaccines / PPEsPPEs
Key Facts For Action……. ♦Relationship between domestic
animals and human Nipah Virus infection
♦Reasons for high prevalence in certain ethnic groups
♦Steps in controlling spread of Nipah Virus in Malaysia
♦Preventing re introduction and spread of Nipah virus
KEDAHP. Langkawi
SELANGOR
N. SEMBILAN
MELAKA
KELANTAN TERENGGANU
PAHANG
Pulau Tioman
JOHOR
THAILAND
PERAK
P .PINANG
Manjung
P.D ickson
B .Pahat
Pont ian
Kinta
PERLIS
K.LangatKe
A .Gajah
Sepang Seremban
Figure 1 : LOCATION of NIPAH VIRUS OUTBREAK in PENINSULAR MALAYSIA
S P U
S P S
>
> >
>
>
>
>
>
>
>
>
Bkt. Minyak
SikamatBkt Pelanduk Site A & Site B
Ampang
>
Kg. Selam at
Damar Laut / Segari
Paya Mengkuang
Pekan Nenas
ValdorBt. Maung
Sepang Tumbok
>Arau
Tumpat >
T U M P A T
>
>
K.KangsarK.Kangsar
C.HighlandC.Highland
GurunK.M uda
M.Tengah Mersing
M ersing
Kuantan >Kuantan
>K.KraiK .K R A I
>
>
>
Pig farm ing areas
Nipah virus outbreak areas
The Nipah Virus Landscape
No of VE Cases According to date of onset from No of VE Cases According to date of onset from epid week 39, epid week 39, 19981998 to week 23 year to week 23 year 19991999
No. of Nipah cases according to Date Onset from Epid Week 39 1998 to Week 19 Year 1999No. of cases
EPID WEEK
Mac,99 Apr. 99
Mei 99
Source: MOH
Outbreak in Kinta locality, Perak State
Outbreak in Kinta, Perak & Sikamat, Negeri Sembilan
Outbreak in Sg Nipah, Bkt Pelanduk, Negeri Sembilan
ContentsContents……..EpidemiologyEpidemiologyInvestigationInvestigationPrevention Prevention and Controland ControlFurther Further researchresearchLessons Lessons LearntLearnt
EpidemiologyEpidemiology……
Cases Cases : : 283 VE cases 283 VE cases admittedadmittedDeaths :Deaths : 110 deaths (VE)110 deaths (VE)Case Fatality rateCase Fatality rate: : 39%39%Occupational history/Occupational history/Exposure history:Exposure history: 80% pig 80% pig farmers and proprietors.farmers and proprietors.
EpidemiologyEpidemiology……Age Age : : Mean age 38 Mean age 38 yrs (2yrs (2--75yrs)75yrs)Age distribution:Age distribution: 52%52%((3030--49yrs),49yrs), 22%22%((above 50 yrs,above 50 yrs, 18%18%(20(20--29yrs)29yrs)Gender distributionGender distribution : : 83% males83% males
Frequency Frequency of Clinical of Clinical SymptomsSymptoms……
Similar toSimilar to Hendra Hendra virusvirus ((Australia , Australia , 1994)1994)EnvelopedEnveloped RNA virusRNA virus21% difference21% difference in the in the nucleotide sequences nucleotide sequences && 11% differences11% differences in in the amino acid the amino acid sequence compared sequence compared to Hendra virusto Hendra virus
Paramyxovirus Paramyxovirus groupgroup……
Transmitted to Transmitted to humans through humans through close contact ofclose contact of body body secretionssecretions of the pigof the pigSusceptible toSusceptible to soapsoap& common & common householdhouseholddetergentsdetergentsLocally namedLocally namedNipah Nipah virusvirus
ImpactImpact……High morbidity & mortalityHigh morbidity & mortality among human among human & animals& animalsMovement (eviction)Movement (eviction) of peopleof peopleDamage to pig farming industryDamage to pig farming industryChange in direction ofChange in direction of futurefuture of pig of pig industryindustrySubstantial Substantial economic losseconomic loss
Prevention & Prevention & ControlControl
InteragencyInteragencyCollaborationCollaboration
National Task forceNational Task forceMinistries of Health, Ministries of Health, Agriculture,Education, Agriculture,Education, Social welfare, Public Social welfare, Public works, Finance, Armed works, Finance, Armed forces, Police ,etc.forces, Police ,etc.
International International collaboration:collaboration:
CDC Atlanta,USACDC Atlanta,USAAustralia Animal Australia Animal Research Research Lab,Geelong,AustraliaLab,Geelong,AustraliaWHO ,WPRO/ WHO ,WPRO/ Geneva,OIEGeneva,OIE..
Health education of Health education of the publicthe public
Strengthen Strengthen SurveillanceSurveillance of of humanshumans (farm (farm workers,army workers,army personnel, MOH,DPH personnel, MOH,DPH staff through testing staff through testing using serologyusing serology
Pigs inPigs in farmfarm ttested ested usingusing serologyserologyPigs atPigs at abattoirs abattoirs selectively selectively screenedscreenedPigs at farms Pigs at farms tested usingtested usingserology and SNTserology and SNT
Protective Protective GearGear
ToTo betterbetter understand understand thethedisease disease To further clarifyTo further clarify modes modes of transmissionof transmissionTo ascertainTo ascertain natural natural history of diseasehistory of disease
Is thereIs there delayed delayed manifestation ?manifestation ?Is thereIs there relapse ?relapse ?Is thereIs there late onset ?late onset ?IsIs reinfectionreinfection possible?possible?
To establishTo establish illness to illness to infection ratioinfection ratio
ResearchResearch……
Research..Research..To know theTo know the natural natural history of the virushistory of the viruswildlife reservoirwildlife reservoirMechanisms & factors Mechanisms & factors associated with associated with transmission oftransmission of Nipah Nipah VirusVirus from animal to from animal to animal, animal to animal, animal to human, & potential human, & potential routes of human to routes of human to human spread.human spread.
lessons lessons Learnt..Learnt..No capacityNo capacity to cope with such to cope with such emerging infectious disease :emerging infectious disease :
Lacking in rapid response Lacking in rapid response Infectious Disease CentreInfectious Disease Centre..
No biosafety labsNo biosafety labs in the in the country to handle an organism country to handle an organism whichwhich CDC classified asCDC classified as a a P4 P4 agent.agent.
Upgraded 2 MOH labs to P3.Upgraded 2 MOH labs to P3.Smart working partnershipSmart working partnershipwith international agencies.with international agencies.
lessons lessons Learnt..Learnt..Poor inPoor in risk communication.risk communication.
Need toNeed to relayrelay the right messagesthe right messages at at the right time , by the right person the right time , by the right person to the right target population .to the right target population .Handling the media.Handling the media.
Pigs may transmit bacterial Pigs may transmit bacterial diseases like anthrax, brucellosisdiseases like anthrax, brucellosisHong Kong Avian influenza. (H5N1)Hong Kong Avian influenza. (H5N1)
The OpportunityAn An allall--hazardshazards, , multisectoral health multisectoral health emergency risk emergency risk management management approach:approach:
Better health outcomes for Better health outcomes for people at risk of people at risk of emergenciesemergencies
Increased capacity to Increased capacity to manage health risks from all manage health risks from all hazardshazards
Resilience of communities Resilience of communities and health systemsand health systems
WAY FORWARDWAY FORWARD…………..Efficient response depends on:Efficient response depends on:
Moving away from a disease based strategy to a Moving away from a disease based strategy to a multi hazard approachmulti hazard approachPreparedness which include innovative Preparedness which include innovative infrastructure, appropriately trained personnel and infrastructure, appropriately trained personnel and adequate fundingadequate fundingAn efficient integrated IT enabled surveillance An efficient integrated IT enabled surveillance system, early alert mechanism & data management system, early alert mechanism & data management CoCo--ordination of various parties involved with well ordination of various parties involved with well defined responsibilities and functionsdefined responsibilities and functionsA clear line of communication and chain of commandA clear line of communication and chain of commandCustomised preventive and control measures Customised preventive and control measures Targeted Risk communication Targeted Risk communication
Ministry of Health Malaysia
WAY FORWARDWAY FORWARD…………contd.contd.Efficient response depends on:Efficient response depends on:
Regional collaborative approach through Regional collaborative approach through established bilateral/multilateral platforms established bilateral/multilateral platforms Strengthening of the Strengthening of the ‘‘One HealthOne Health’’ agendaagendaSmart integrative compliance to existing Smart integrative compliance to existing international conventions and agreementsinternational conventions and agreementsApplication of select lessons learnt during Application of select lessons learnt during previous incident experienceprevious incident experiencePreparing for that element of surprise and Preparing for that element of surprise and anticipating a worst case scenarioanticipating a worst case scenario
Acknowledgement and Acknowledgement and AppreciationAppreciation
DirectorDirector--General of Health MalaysiaGeneral of Health Malaysia
Deputy DirectorDeputy Director--General (Public Health) and General (Public Health) and Director of Disease Control, MOH MalaysiaDirector of Disease Control, MOH Malaysia
Ministry of Foreign Affairs MalaysiaMinistry of Foreign Affairs Malaysia
Assistance of related Agencies in MalaysiaAssistance of related Agencies in Malaysia
UNODA, EU and the Implementation Support Unit UNODA, EU and the Implementation Support Unit of the BTWCof the BTWC
To various persons for use of content in selected To various persons for use of content in selected slides in this presentationslides in this presentation
Organisers & Secretariat of this Regional Workshop Organisers & Secretariat of this Regional Workshop